Without a stable base, it’s only a matter of time before a system begins to breakdown. For our bodies, the pelvis and the muscles that surround it are our foundation.The hips don’t lie…Shakira had it right. Maintaining adequate hip strength and deep core control are necessary for keeping that foundation stable. Runners with hip weakness and poor trunk control won’t be able to support the demands that are being placed on their systems long-term, ultimately leading to breakdown and the development of running related injuries (RRIs).
So what do I mean by the deep core? Let’s define that before we go further. The deep core, not to be confused with what most people think to be your six-pack abs, is made up four important muscles: the diaphragm, pelvic floor, transverse abdominis, and multifidus. This is what I call your first string players (aka your MVPs); the local system that provides stability throughout the pelvic girdle. Proper activation of this proximal system is necessary for the achievement of distal mobility of our extremities during activities . What do I mean by this? When we’re strong and grounded in our center the rest of our body can move fluidly without needing to overcome added resistance. However, if the deep core is not engaged, it leaves our bodies with no other choice but to find stability elsewhere through compensatory movement strategies. Our arms and legs have to figure out how to create a stable base somewhere else while also trying to move simultaneously. In order to do this, the body over recruits surrounding muscle groups – low back muscles, hip flexors, hamstrings – to fill in for the absence of our deep core. When those recruited muscles get overworked, they become tight and restrict movement. See what I mean by having to overcome added resistance? Such dysfunction can go undetected for a while since the body is highly adaptable, but that’s not helpful long-term since faulty movement strategies increase your risk for injury. This leads me to my next point about how an unstable foundation affects hip mechanics and the development of lower extremity injuries .
The hip and deep core are designed to work together as a team. Think of them like a married couple. When they are in sync, the coordination of movement is efficient and can appear effortless. However, when they’re not communicating well or if someone in the relationship isn’t completing their fair share of responsibilities, the other person will usually pick up the slack for a certain amount of time, but eventually becomes resentful and problems arise. Same is true for the hip and deep core relationship. When walking or running, the pelvis needs to be level with respect to the ground below. Remember, it’s our foundation. In order for this to be accomplished, both the deep core and external rotators of the hip need have adequate strength and coordination between them [2-3]. If either of these players fails to perform properly the system suffers, resulting in abnormal movement (aka trendelenberg gait pattern). When the pelvis is unable to maintain its parallel position, abnormal loading mechanics will occur throughout the hip, knee and ankle. Eventually this will lead to the development of overuse injuries, most commonly being: IT band syndrome (ITBS), Patellofemoral Pain Syndrome (PFPS), Achilles tendonopathies, and/or plantar fasciitis [4-6].
If you’ve had, or are currently working through, any of the injuries I just mentioned, your body is struggling with a dysfunctional deep core and hip relationship. This is a very common problem among runners that can be easily addressed with guidance from a physical therapist and by regularly performing the right strengthening program. As I’ve explained in previous posts, your best predictor for future injury is your previous history of injury. So, do yourself a favor and be proactive about nurturing your deep core and hip relationship before things get rocky.
For those of you who are unclear about where to start with your deep core and hip strengthening program, you’re in luck! I’ve created a video that includes five exercises I advise my patients to perform 2-3x/week in order to maintain a solid foundation and keep running strong! The best part? You can do all of these at home without any equipment. It’s that easy – no excuses!
- Shinkle, Justin, et al. “Effect of core strength on the measure of power in the extremities.” The Journal of Strength & Conditioning Research 26.2 (2012): 373-380.
- Semciw, Adam, Racheal Neate, and Tania Pizzari. “Running related gluteus medius function in health and injury: A systematic review with meta-analysis.”Journal of Electromyography and Kinesiology 30 (2016): 98-110.
- Ebert, J. R., et al. “A Systematic Review of Rehabilitation Exercises to Progressively Load Gluteus Medius.” Journal of sport rehabilitation (2016).
- Benke, Michael T., Christopher M. Powers, and Bert R. Mandelbaum. “Prevention of Patellofemoral Injuries.” The Patellofemoral Joint. Springer Berlin Heidelberg, 2014. 51-57.
- Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated with hours of training in master running athletes. Foot Ankle Int. 2008 Jul; 29(7):671-6
- van Gent, Bobbie RN, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine (2007)
- Deep core photo source: source: http://www.fixprogram.com/blog/post/Pilates-and-the-deep-core-muscles-of-the-pelvis
- Trendelenberg gait photo source: source: http://pomidoranet.com/trendelenburg-pattern-gait/